Morning Report

Morning Report: 3/21/14

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Dr. Shin presents today’s special March Madness edition of Morning Report!

 

Inferior Alveolar Nerve Block

 

A nerve block of the intraoral mandibular or inferior alveolar nerve anesthetizes the following:

  • The body of the mandible and the lower portion of the ramus
  • All mandibular teeth
  • The floor of the mouth
  • The anterior two thirds of the tongue
  • Gingivae on the lingual surface of the mandible
  • Gingivae on the labial surface of the mandible
  • Mucosa and skin of the lower lip and chin

 

Equipment

  • An overhead light of sufficient intensity should be present.
  • Sterile thumb-control syringe
  • Topical anesthetic (in the form of pastes or gels)
  • 2% lidocaine with epinephrine or 0.5% bupivacaine with epinephrine
  • Cotton-tipped applicators to administer topical anesthetic and control bleeding
  • Small-gauge needles (The longer the needle, the easier the inferior alveolar nerve block is to accomplish.)
    • Approximately 1.5-2 inches

 

The technique is as follows, based on the description of Powell

  • Apply topical anesthetic to the target area
  • Place the thumb of the nondominant hand on the coronoid notch and the index finger just anterior to the ear to stretch the tissues over the injection site
  • With the anterior ramus technique, palpate the anterior border of the ramus with the thumb and find the greatest concavity, which is the coronoid notch.
  • Orient the syringe so that the barrel is in the opposite corner of the mouth, resting on the premolars.
  • Aim toward the index finger and slowly penetrate the mucosa until bone is contacted.
    • If the attempt does not result in contact with bone, reorient the syringe more laterally and repeat attempt.
  • Withdraw slightly and aspirate.
    • Rotate the bevel of the needle and re-aspirate; if no blood is returned, inject 1.5-2 mL of anesthetic.
    • If aspiration is positive, pull back about 5 mm and redirect slightly, then repeat attempt at aspiration.
  • If the injection fails to result in adequate analgesia, it may safely be repeated 2 additional times

 

References:

Scheinfeld, NS. Inferior Alveolar Nerve Block. Emedicine http://emedicine.medscape.com/article/82622-overview#a15

 

Ok, nothing specific to basketball but still good stuff!

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital
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